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Request for Statutory Invention Registration Template by Biscuit350

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									         Doc Code:                                                                                                                             PTO/SB/94 (05-07)
                                                                                                          Approved for use through 04/30/2009. OMB 0651-0036
                                                                                      U.S. Patent and Trademark Office; U.S. DEPARTMENT OF COMMERCE
      Under the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number.


                           Request for Statutory Invention Registration
Application Number                                                   , or         attached hereto

Filed:

Applicant(s):

Title:




A. In the above identified patent application, I hereby:
1. Request and authorize the Director of the U.S. Patent and Trademark Office to publish the above identified regularly filed
   patent application as a Statutory Invention Registration. (35 U.S.C. 157)

2. Waive the right to receive a United States patent on the same invention claimed in the above identified patent application.
   These rights, which are waived, include those specified in 35 U.S.C. 183 and 271 through 289 as well as all attributes
   specified for patents in any other provisions of law other than title 35, United States Code. The waiver includes, but is not
   limited to, the remedies under 19 U.S.C. 1337, 22 U.S.C. 2356 and 28 U.S.C. 1498. (35 U.S.C. 157(c))

3. Understand that the above waiver will be effective pursuant to 37 CFR 1.293 upon publication of the Statutory Invention
   Registration to waive the inventor's right to receive a United States patent on the invention claimed in the Statutory
   Invention Registration. (37 CFR 1.293(b)(1))

4. State that, in my opinion, the disclosure and claims of the above identified patent application meet the requirements of
   35 U.S.C. 112. (37 CFR 1.293(b)(3))

5. State that, in my opinion, the above identified patent application complies with the requirements for printing as set forth in
   the Rules of Practice for Patent Cases, 37 CFR Part 1. (37 CFR 1.293(b)(4))

6. Enclose the fee set forth in 37 CFR 1.17(n) or (o) for requesting publication of a Statutory Invention Registration:

         A first Office Action has not been mailed in the above application, 37 CFR 1.17(n) (fee code 1804) $

         A first Office Action has been mailed in the above application, 37 CFR 1.17(o) (fee code 1805)                                    $

                                                                                                                   Request fee             $

           MINUS BASIC FILING FEE, IF PREVIOUSLY PAID

         Basic filing fee for utility patent application set forth in 37 CFR 1.16(a);

         Basic filing fee for design patent application set forth in 37 CFR 1.16(f); or

         Basic filing fee for plant patent application set forth in 37 CFR 1.16(g)
         Minus basic filing fee $ _______________.
                                                                                               Amount due $ ____________
         Payment charged to credit card ______________. Form PTO-2038 is attached.
         Amount enclosed by check or money order _____________.
         Please charge Deposit Account No. __________________ the amount of $ _________________. A duplicate copy of
              this form is attached.
         If payment of any additional fee is required for publication of the Statutory Invention Registration, charge such amount to
         Deposit Account No.                             . A duplicate copy of this form is attached.


* Where this request is submitted at the time the application is filed, the filing fee is included in the fee.
                                                                                 [Page 1 of 2]
This collection of information is required by 35 U.S.C. 157. The information is required to obtain or retain a benefit by the public which is to file (and by the USPTO
to process) an application. Confidentiality is governed by 35 U.S.C. 122 and 37 CFR 1.11 and 1.14. This collection is estimated to take 24 minutes to complete,
including gathering, preparing, and submitting the completed application form to the USPTO. Time will vary depending upon the individual case. Any comments
on the amount of time you require to complete this form and/or suggestions for reducing this burden, should be sent to the Chief Information Officer, U.S. Patent
and Trademark Office, U.S. Department of Commerce, P.O. Box 1450, Alexandria, VA 22313-1450. DO NOT SEND FEES OR COMPLETED FORMS TO THIS
ADDRESS. SEND TO: Commissioner for Patents, P.O. Box 1450, Alexandria, VA 22313-1450.
                               If you need assistance in completing the form, call 1-800-PTO-9199 and select option 2.
                                                                                                                                              PTO/SB/94 (05-07)
         Doc Code:                                                                                       Approved for use through 04/30/2009. OMB 0651-0036
                                                                                     U.S. Patent and Trademark Office; U.S. DEPARTMENT OF COMMERCE
     Under the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number.

B. For printing of the Statutory Invention Registration front page, if desired, list below the name(s) of not more than 3
   registered patent attorneys and agents OR alternatively, the name of a firm having as a member a registered patent
   attorney or agent. If no name is listed below, no name will be printed on the Statutory Invention Registration.

   ______________________________________________________________________________________________

   ______________________________________________________________________________________________.

C. Name of assignee, if any, for printing on the Statutory Invention Registration __________________________________


   Address (City and State or Country) __________________________________________________________________.

   State of incorporation, if assignee is a corporation _______________________________________________________.




WARNING: Information on this form may become public. Credit card information should not be included on this
form. Provide credit card information and authorization on PTO-2038.


The party or parties signing this form are:

          attorney or agent of record. Registration Number________________.

          applicant(s) and any assignee




                                                          Signature(s) (37 CFR 1.293(a))



                                                             Typed or Printed Name(s)



                 Registration Number, if applicable                                                     Telephone Number




                                                                        [Page 2 of 2]
                                        Privacy Act Statement

The Privacy Act of 1974 (P.L. 93-579) requires that you be given certain information in connection
with your submission of the attached form related to a patent application or patent. Accordingly,
pursuant to the requirements of the Act, please be advised that: (1) the general authority for the
collection of this information is 35 U.S.C. 2(b)(2); (2) furnishing of the information solicited is voluntary;
and (3) the principal purpose for which the information is used by the U.S. Patent and Trademark
Office is to process and/or examine your submission related to a patent application or patent. If you do
not furnish the requested information, the U.S. Patent and Trademark Office may not be able to
process and/or examine your submission, which may result in termination of proceedings or
abandonment of the application or expiration of the patent.

The information provided by you in this form will be subject to the following routine uses:

    1.   The information on this form will be treated confidentially to the extent allowed under the
         Freedom of Information Act (5 U.S.C. 552) and the Privacy Act (5 U.S.C 552a). Records from
         this system of records may be disclosed to the Department of Justice to determine whether
         disclosure of these records is required by the Freedom of Information Act.
    2.   A record from this system of records may be disclosed, as a routine use, in the course of
         presenting evidence to a court, magistrate, or administrative tribunal, including disclosures to
         opposing counsel in the course of settlement negotiations.
    3.   A record in this system of records may be disclosed, as a routine use, to a Member of
         Congress submitting a request involving an individual, to whom the record pertains, when the
         individual has requested assistance from the Member with respect to the subject matter of the
         record.
    4.   A record in this system of records may be disclosed, as a routine use, to a contractor of the
         Agency having need for the information in order to perform a contract. Recipients of
         information shall be required to comply with the requirements of the Privacy Act of 1974, as
         amended, pursuant to 5 U.S.C. 552a(m).
    5.   A record related to an International Application filed under the Patent Cooperation Treaty in
         this system of records may be disclosed, as a routine use, to the International Bureau of the
         World Intellectual Property Organization, pursuant to the Patent Cooperation Treaty.
    6.   A record in this system of records may be disclosed, as a routine use, to another federal
         agency for purposes of National Security review (35 U.S.C. 181) and for review pursuant to
         the Atomic Energy Act (42 U.S.C. 218(c)).
    7.   A record from this system of records may be disclosed, as a routine use, to the Administrator,
         General Services, or his/her designee, during an inspection of records conducted by GSA as
         part of that agency’s responsibility to recommend improvements in records management
         practices and programs, under authority of 44 U.S.C. 2904 and 2906. Such disclosure shall
         be made in accordance with the GSA regulations governing inspection of records for this
         purpose, and any other relevant (i.e., GSA or Commerce) directive. Such disclosure shall not
         be used to make determinations about individuals.
    8.   A record from this system of records may be disclosed, as a routine use, to the public after
         either publication of the application pursuant to 35 U.S.C. 122(b) or issuance of a patent
         pursuant to 35 U.S.C. 151. Further, a record may be disclosed, subject to the limitations of 37
         CFR 1.14, as a routine use, to the public if the record was filed in an application which
         became abandoned or in which the proceedings were terminated and which application is
         referenced by either a published application, an application open to public inspection or an
         issued patent.
    9.   A record from this system of records may be disclosed, as a routine use, to a Federal, State,
         or local law enforcement agency, if the USPTO becomes aware of a violation or potential
         violation of law or regulation.

								
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